Is it Really Sciatica?

When faced with a patient complaining of  buttock pain many doctors  automatically give a diagnosis of sciatica. I have seen many cases of "sciatica" resolve with only a few treatments. What does this mean? It means that another nerve was affected since true sciatica rarely clears up quickly. That other nerve is usually the cluneal nerve. This nerve originates much higher than the hip in the area where the rib cage and lower thoracic spine transition to the lumbar spine. The cluneal nerve travels down to the iliac crest where it is contained in a fibrous tunnel.

How can you tell if the sciatic nerve or cluneal nerve entrapment is causing your pain? Location of the pain is an important differentiating factor. First it is important to define the hip anatomically. When asked to point to the hip some patients point to prominence on their side which is actually the femur head. Others pinpoint the the dimple just below the center of the back which is the sacroiliac joint. Finally, some patients correctly run their hand around the entire area including the buttock and groin.

If the pain you are feeling is located just lateral and above the dimple or sacroiliac joint, then there is a good chance that the cluneal nerve is pinched or compressed. Sciatic nerve pain is usually located more central and lower and includes pain radiating down the back of the leg. The ishium or "sit bone" area is often an area of extreme tenderness.

Now, what do you do about it? The best treatment for either of these common cases of bio-mechanical dysfunction is a mechanical treatment known as an adjustment which works the cluneal nerve loose in its tunnel so it can glide normally without tension. In the case of sciatica, adjustments along with acupuncture often help but healing time is typically longer.